| NPI | 1821009515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X (Licence: MD D0028870) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0028870) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2025-09-11 |