| NPI | 1215420195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 88589) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 276102) |
| Enumeration Date | 2018-06-14 |
| Last Update Date | 2024-08-10 |