| NPI | 1497017354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD170854) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2012016484) |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2022-02-04 |