| NPI | 1588292692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 81951-21) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS19895) |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2026-02-11 |