| NPI | 1114414265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 187313) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR PG188468) |
| Enumeration Date | 2018-04-15 |
| Last Update Date | 2026-08-14 |