| NPI | 1871156737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 84946) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD 13609) |
| Enumeration Date | 2019-04-17 |
| Last Update Date | 2025-02-03 |