| NPI | 1083642417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 25076) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD20185) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2026-04-06 |