| NPI | 1689306946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 85717) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2022024128) |
| Enumeration Date | 2022-06-27 |
| Last Update Date | 2026-02-18 |