| NPI | 1760688568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD190891) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM RS2007-0387) |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2019-12-20 |