| NPI | 1669573457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: FL OS0003264) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS0003264) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2025-09-11 |