| NPI | 1891433595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 37173) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-12436) |
| Enumeration Date | 2022-05-23 |
| Last Update Date | 2025-11-24 |