| NPI | 1083819460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 7668) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101244819) |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2026-08-18 |