| NPI | 1154815983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO211333) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 009138) |
| Enumeration Date | 2018-06-15 |
| Last Update Date | 2022-11-30 |