| NPI | 1568555001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID 0-1839) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR DO19768) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2026-01-16 |