| NPI | 1497745525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2017-00394) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102050143) |
| 207Q00000X Family Medicine (Licence: IA 04583) | |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2025-01-14 |