| NPI | 1962743617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 219797) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC NC1150614) |
| Enumeration Date | 2013-03-05 |
| Last Update Date | 2025-04-22 |