| NPI | 1053911495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2020021419) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2020021419) |
| Enumeration Date | 2020-10-26 |
| Last Update Date | 2020-11-21 |