| NPI | 1528643863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL 20590) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GU DO-P-2025-001) |
| Enumeration Date | 2021-03-17 |
| Last Update Date | 2025-11-18 |