| NPI | 1306819800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA 08018161) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR DO153448) |
| 208D00000X General Practice (Licence: CA 20A8361) | |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2022-02-02 |