| NPI | 1336227834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 38986-21) |
| Additional Taxonomies | 202K00000X (Licence: WI 38986-21) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2025-03-04 |