| NPI | 1356533863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine Adult Medicine (Licence: MO 2016010160) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 21305) |
| Enumeration Date | 2007-08-17 |
| Last Update Date | 2025-07-15 |