| NPI | 1114992674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 23232) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 35697) |
| Enumeration Date | 2006-02-20 |
| Last Update Date | 2026-02-27 |