| NPI | 1639557341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 009251) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 1552) |
| Enumeration Date | 2015-05-13 |
| Last Update Date | 2025-05-02 |