| NPI | 1609442821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 28631) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4351047523) |
| Enumeration Date | 2021-05-28 |
| Last Update Date | 2026-09-17 |