| NPI | 1881043560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO195603) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR PG178041) |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2026-01-30 |