| NPI | 1871517185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 84157) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2007-01580) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2026-03-31 |