| NPI | 1619919230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 9801236) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 1024334) |
| 207Q00000X Family Medicine (Licence: GA 98324) | |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2025-11-04 |