| NPI | 1659020287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS21597) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL UO8729) |
| Enumeration Date | 2022-03-21 |
| Last Update Date | 2025-03-24 |