| NPI | 1598347585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 82863-20) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WI 82863-20) |
| Enumeration Date | 2021-04-28 |
| Last Update Date | 2025-05-08 |