| NPI | 1164801692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O-1030) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRO-1490) |
| Enumeration Date | 2015-05-29 |
| Last Update Date | 2023-12-15 |