| NPI | 1013993880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD172387) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 27277) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2020-11-04 |