| NPI | 1356425946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 171153) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR DO22827) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2026-03-23 |