| NPI | 1568805422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A152742) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 29880) |
| 207Q00000X Family Medicine (Licence: VA 0101261369) | |
| Enumeration Date | 2013-04-10 |
| Last Update Date | 2025-07-14 |