| NPI | 1700234135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SD 16776) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 30226) |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2025-09-30 |