| NPI | 1811938616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2024047325) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA MD-38445) |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2026-02-16 |