| NPI | 1952806267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2025-01006) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 21444) |
| 207Q00000X Family Medicine (Licence: AZ 67307) | |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2026-08-06 |