| NPI | 1205213378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL MM15440) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: FL M154400) |
| Enumeration Date | 2015-04-28 |
| Last Update Date | 2023-04-24 |