| NPI | 1659807667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS19635) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS019659) |
| Enumeration Date | 2017-05-10 |
| Last Update Date | 2026-05-06 |