| NPI | 1619471125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 33627) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA MD-51482) |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2025-10-14 |