| NPI | 1205218393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 331368) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 24855) |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2023-04-21 |