| NPI | 1760446264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 87751) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS19141) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2025-12-29 |