| NPI | 1427388925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 48655) |
| Additional Taxonomies | 202D00000X Integrative Medicine (Licence: AZ 48655) |
| Enumeration Date | 2010-01-05 |
| Last Update Date | 2026-07-14 |