| NPI | 1851405401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME 65142) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-43171) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2025-03-27 |