| NPI | 1780324483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID 2871955) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 9844) |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2025-08-01 |