| NPI | 1881250363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS16964) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 91359) |
| Enumeration Date | 2019-05-10 |
| Last Update Date | 2026-02-18 |