| NPI | 1740776376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 61173) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL61173) |
| Enumeration Date | 2018-07-06 |
| Last Update Date | 2026-09-03 |