| NPI | 1417390089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2024-00329) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 301884) |
| Enumeration Date | 2013-04-12 |
| Last Update Date | 2025-12-26 |