| NPI | 1609075746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC LL30123) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 65465) |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2026-02-24 |