| NPI | 1811043284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 200600757) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2006-00757) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2025-12-01 |