| NPI | 1841789112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301506488) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 11410962-1205) |
| Enumeration Date | 2018-05-02 |
| Last Update Date | 2026-05-14 |