| NPI | 1245367630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR PA213975) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 305) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2023-08-01 |