| NPI | 1780352088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4351049950) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: NC RTL250911328905) |
| Enumeration Date | 2021-09-01 |
| Last Update Date | 2026-04-30 |