| NPI | 1871089961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301504260) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301116147) |
| Enumeration Date | 2018-07-02 |
| Last Update Date | 2025-08-26 |