| NPI | 1487175535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS17098) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT018026) |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2025-03-17 |