| NPI | 1932326493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD153379) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND 9966) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2021-03-10 |