| NPI | 1154374965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD199547) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2009-0628) |
| 207Q00000X Family Medicine (Licence: WA MD60746432) | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2021-05-14 |