| NPI | 1538105747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR 17786) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD17786) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2024-03-13 |