| NPI | 1942664701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 95030) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 65893) |
| 207Q00000X Family Medicine (Licence: CA A160814) | |
| 207Q00000X Family Medicine (Licence: OR MD187402) | |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2025-09-09 |