| NPI | 1346236809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 35733) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 148393) |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2026-09-09 |