| NPI | 1184916744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD229693) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 29431) |
| Enumeration Date | 2011-05-13 |
| Last Update Date | 2026-05-08 |