| NPI | 1649621038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2019-00265) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 23600) |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2025-06-20 |