| NPI | 1235131483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: AL AL7617) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL AL7617) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2025-03-05 |