| NPI | 1477287324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2025028752) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND 18523) |
| Enumeration Date | 2022-07-14 |
| Last Update Date | 2025-09-05 |