| NPI | 1619955846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 92700) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 200101034) |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2025-04-14 |