| NPI | 1538212485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301082421) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI FS082421) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2026-01-27 |