| NPI | 1730178914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-34238) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 42222) |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2025-07-31 |