| NPI | 1518929967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: NV 8854) |
| Additional Taxonomies | 202D00000X Integrative Medicine (Licence: NV 8854) |
| 207Q00000X Family Medicine (Licence: NV 8854) | |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2025-10-01 |