| NPI | 1881333623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 87941) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC MMD.87941) |
| Enumeration Date | 2022-05-31 |
| Last Update Date | 2025-07-30 |