| NPI | 1740975267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 84501-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 100116) |
| Enumeration Date | 2023-04-10 |
| Last Update Date | 2025-08-06 |