| NPI | 1053433441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI 14081) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT 144979) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2026-02-10 |