| NPI | 1770071722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 2094) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 8246) |
| Enumeration Date | 2018-04-25 |
| Last Update Date | 2025-07-31 |