| NPI | 1275501215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD08651) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101029437) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2020-10-28 |