| NPI | 1447248463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: MN 76479) |
| Additional Taxonomies | 2085R0001X (Licence: WI 85189) |
| 2085R0001X (Licence: CA C55553) | |
| 207Q00000X Family Medicine (Licence: TX L2310) | |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2025-11-14 |