| NPI | 1740930601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 010654) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS20777) |
| 207Q00000X Family Medicine (Licence: ID 6161277) | |
| Enumeration Date | 2022-03-24 |
| Last Update Date | 2025-03-31 |