| NPI | 1366421208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 87488) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 200001084) |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2026-08-19 |