| NPI | 1205891215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 54351) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2022-1340) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2025-05-06 |