| NPI | 1760534861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM md2011-0623) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID M-9759) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2025-10-01 |