| NPI | 1225028855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 45695) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 24114) |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2025-08-18 |