| NPI | 1437332780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101248230) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60077699) |
| 207Q00000X Family Medicine (Licence: TX BP10027421) | |
| Enumeration Date | 2007-12-10 |
| Last Update Date | 2025-07-26 |