| NPI | 1013279918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2021013100) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 6757) |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2024-09-19 |