| NPI | 1609570076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 114343) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-12775) |
| Enumeration Date | 2023-03-29 |
| Last Update Date | 2026-08-20 |