| NPI | 1205196417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD171022) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND RL12297) |
| Enumeration Date | 2012-05-22 |
| Last Update Date | 2021-12-20 |