| NPI | 1194761817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 022900) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA C50813) |
| 207Q00000X Family Medicine (Licence: NC 2005-00541) | |
| 207Q00000X Family Medicine (Licence: OR MD161972) | |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2025-12-12 |