| NPI | 1114928470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 38051) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 15115) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2025-12-12 |