| NPI | 1700033925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD18316) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 364110-1205) |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2024-08-15 |