| NPI | 1861705865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO166588) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS014673) |
| Enumeration Date | 2010-07-19 |
| Last Update Date | 2025-12-11 |