| NPI | 1922446970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2016-01140) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL35679) |
| Enumeration Date | 2013-06-12 |
| Last Update Date | 2025-04-24 |