| NPI | 1205091576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD154230) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND TRL10887) |
| Enumeration Date | 2008-07-25 |
| Last Update Date | 2020-10-14 |