| NPI | 1043535941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 58861) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 205682) |
| Enumeration Date | 2010-04-02 |
| Last Update Date | 2025-06-12 |