| NPI | 1336231539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL 19852) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME 1303) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2026-08-17 |