| NPI | 1063860245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS16399) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL39235) |
| Enumeration Date | 2016-05-29 |
| Last Update Date | 2023-02-09 |