| NPI | 1053382614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD27464) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 11111) |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2021-11-12 |