| NPI | 1962584417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL NA) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI MD-25656) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2026-03-13 |