| NPI | 1548351877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD172848) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2012-0883) |
| 207Q00000X Family Medicine (Licence: WI 49619) | |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2021-03-22 |