| NPI | 1942378757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301060797) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101286372) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2025-09-25 |