| NPI | 1487188694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 40777) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC MD40777) |
| Enumeration Date | 2017-04-13 |
| Last Update Date | 2025-03-10 |