| NPI | 1528004389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M7815) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD203385) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2025-08-27 |