| NPI | 1053806182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 92216) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4351028541) |
| Enumeration Date | 2018-07-01 |
| Last Update Date | 2024-06-10 |