| NPI | 1124476072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M14205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRM-1586) |
| Enumeration Date | 2016-06-01 |
| Last Update Date | 2021-04-07 |