| NPI | 1285680264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 18638) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD28720) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2020-08-11 |