| NPI | 1104315688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2021-01586) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 202101586) |
| Enumeration Date | 2018-05-09 |
| Last Update Date | 2021-07-09 |