| NPI | 1023096880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 16918) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301405797) |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2026-02-03 |