| NPI | 1487686440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD28903) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 200501267) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2020-11-03 |