| NPI | 1447816822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 322797) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 05546) |
| Enumeration Date | 2019-05-11 |
| Last Update Date | 2026-06-09 |