| NPI | 1194162883 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2022017094) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 076204) |
| Enumeration Date | 2013-06-04 |
| Last Update Date | 2022-08-12 |