| NPI | 1922267939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 26219) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301092263) |
| Enumeration Date | 2008-06-04 |
| Last Update Date | 2025-05-20 |