| NPI | 1861068371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO228370) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM DO2024-0116) |
| Enumeration Date | 2021-06-03 |
| Last Update Date | 2026-06-11 |