| NPI | 1356331854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 011289) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 47860) |
| 207Q00000X Family Medicine (Licence: AR E-6825) | |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2025-08-23 |