| NPI | 1457662967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO182303) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2012013499) |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2022-02-04 |