| NPI | 1619663374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO231274) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRO-2244) |
| Enumeration Date | 2023-04-14 |
| Last Update Date | 2026-06-02 |