| NPI | 1417311762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: SC 95876) |
| Additional Taxonomies | 2085R0001X (Licence: AR E-14037) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: MI 390200000) | |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2025-12-22 |