| NPI | 1114020708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX M7400) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX M7400) |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2026-01-08 |