| NPI | 1598442477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-56753) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 9765) |
| Enumeration Date | 2023-07-03 |
| Last Update Date | 2026-07-15 |