| NPI | 1538659909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2026012115) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-44433) |
| Enumeration Date | 2018-05-11 |
| Last Update Date | 2026-05-06 |