| NPI | 1497044507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 143387) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD167582) |
| Enumeration Date | 2011-03-30 |
| Last Update Date | 2025-01-22 |