| NPI | 1215497235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 329365) |
| Additional Taxonomies | 208D00000X General Practice (Licence: LA 329365) |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2023-12-20 |