| NPI | 1245231331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0076100) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 200200189) |
| 207Q00000X Family Medicine (Licence: MO 2025017298) | |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2025-10-22 |