| NPI | 1144481441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 38572) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IA 38572) |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2025-06-15 |