| NPI | 1952567455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2013-0580) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD 60214673) |
| 207Q00000X Family Medicine (Licence: OH 35.097091) | |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2023-08-21 |