| NPI | 1962060699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD223741) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.148464) |
| 207Q00000X Family Medicine (Licence: CA A200678) | |
| 2083C0008X Preventive Medicine, Clinical Informatics Specialist (Licence: OR MD223741) | |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2025-06-29 |