| NPI | 1457446163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 95799) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 009601172) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2026-04-15 |