| NPI | 1952780876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2018-02874) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL37649) |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2025-10-13 |