| NPI | 1538149653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO150938) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 056859) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2022-02-10 |