| NPI | 1497850093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS5744) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care (Licence: FL OS7744) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2026-04-03 |