| NPI | 1730386301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101244887) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: GA 002417) |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2025-08-19 |