| NPI | 1093129520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2021-01009) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 270329) |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2022-05-11 |