| NPI | 1942564281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD174000) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 6536) |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2020-04-23 |