| NPI | 1548991045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID 5581812) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL UO8646) |
| Enumeration Date | 2022-06-23 |
| Last Update Date | 2026-07-16 |