| NPI | 1366426074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 30642) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 5203) |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2026-07-09 |