| NPI | 1922067537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 9800270) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC nc9800270) |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2025-06-24 |