| NPI | 1306283056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO206226) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 9740447-1204) |
| Enumeration Date | 2013-06-03 |
| Last Update Date | 2024-07-30 |