| NPI | 1851034540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO-06618) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-12620) |
| Enumeration Date | 2022-04-19 |
| Last Update Date | 2025-08-11 |