| NPI | 1801202312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 324142) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR DO225068) |
| Enumeration Date | 2014-07-03 |
| Last Update Date | 2025-11-13 |