| NPI | 1043877137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101026124) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5151013713) |
| Enumeration Date | 2019-05-23 |
| Last Update Date | 2022-07-19 |