| NPI | 1992386940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301511926) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2020031547) |
| 207Q00000X Family Medicine (Licence: MI 4351049233) | |
| Enumeration Date | 2021-04-20 |
| Last Update Date | 2026-04-07 |