| NPI | 1013978626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: PA 05002807L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA 05002807) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2025-09-11 |