| NPI | 1982981809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO169607) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OR PG156700) |
| Enumeration Date | 2011-11-06 |
| Last Update Date | 2025-01-31 |