| NPI | 1952321606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD217942) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID M-9668) |
| 207Q00000X Family Medicine (Licence: WY 7198A) | |
| 207Q00000X Family Medicine (Licence: WA MD61680443) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2026-07-21 |