| NPI | 1932494853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2026-04036) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 33829) |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2026-08-20 |