| NPI | 1225398019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2022012436) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 28700) |
| Enumeration Date | 2012-05-25 |
| Last Update Date | 2022-04-14 |