| NPI | 1386060887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2018-02175) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 28706) |
| Enumeration Date | 2014-03-09 |
| Last Update Date | 2026-04-28 |