| NPI | 1073741500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 46818) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 31929) |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2026-04-30 |