| NPI | 1962148452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 37078) |
| Additional Taxonomies | 3747P1801X Technician, Personal Care Attendant |
| Enumeration Date | 2022-05-09 |
| Last Update Date | 2026-03-17 |