| NPI | 1225689748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 7546357-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND RL16538) |
| 208D00000X General Practice (Licence: UT 7546357-1205) | |
| Enumeration Date | 2019-09-25 |
| Last Update Date | 2023-11-23 |