| NPI | 1033599923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2018012782) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 0000000) |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2020-11-19 |