| NPI | 1285602284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2025010711) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 23434) |
| 207Q00000X Family Medicine (Licence: VA 0101235713) | |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2025-06-05 |