| NPI | 1760063739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI DOS-2674-0) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2024-01933) |
| Enumeration Date | 2021-04-20 |
| Last Update Date | 2025-08-13 |