| NPI | 1003331919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS15463) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: FL 5253) |
| Enumeration Date | 2017-08-11 |
| Last Update Date | 2024-04-02 |