| NPI | 1265497846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID 6161371) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD21220) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2025-05-08 |