| NPI | 1417446618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 008310) |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty (Licence: AZ 008310) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: AZ 008310) | |
| 207R00000X Internal Medicine (Licence: AZ 008310) | |
| Enumeration Date | 2018-05-03 |
| Last Update Date | 2026-02-26 |