| NPI | 1932550936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A23067) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 20A23067) |
| 171000000X Military Health Care Provider | |
| Enumeration Date | 2016-06-30 |
| Last Update Date | 2026-06-15 |