| NPI | 1649373440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2008025165) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO T2006016537) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2026-04-07 |