| NPI | 1053971606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 03221) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 28496) |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2024-12-11 |