| NPI | 1487066643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO208318) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA DO05204) |
| Enumeration Date | 2014-05-22 |
| Last Update Date | 2026-04-01 |