| NPI | 1306088943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD186677) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 257372) |
| Enumeration Date | 2009-03-27 |
| Last Update Date | 2023-01-30 |