| NPI | 1518583236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 81936) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4351046904) |
| Enumeration Date | 2020-06-18 |
| Last Update Date | 2026-07-17 |