| NPI | 1992850036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 13156) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 05-48753) |
| 207Q00000X Family Medicine (Licence: NE 268) | |
| 207Q00000X Family Medicine (Licence: OR DO159668) | |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2025-12-16 |