| NPI | 1962142679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 77703) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ TP01634) |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2025-09-24 |