| NPI | 1841936184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 21769) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND RL18565) |
| Enumeration Date | 2022-05-10 |
| Last Update Date | 2025-05-21 |