| NPI | 1629154554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 42964) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 200000645) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2025-09-26 |