| NPI | 1831400597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 48025) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 133014) |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2026-01-20 |