| NPI | 1457431991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS025512) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A10757) |
| 207Q00000X Family Medicine (Licence: CO DR-46006) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2026-02-11 |