| NPI | 1679547533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2022-03128) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101247969) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2025-09-24 |