| NPI | 1659066744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC LL89997) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 112140) |
| Enumeration Date | 2023-04-06 |
| Last Update Date | 2026-04-19 |