| NPI | 1255591962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD187564) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2011-0024) |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2018-09-12 |