| NPI | 1871485037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4351053915) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5315256072) |
| Enumeration Date | 2025-07-21 |
| Last Update Date | 2025-07-21 |