| NPI | 1235506387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS15349) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 81689-21) |
| 207Q00000X Family Medicine (Licence: VA 0102206352) | |
| Enumeration Date | 2015-08-25 |
| Last Update Date | 2024-10-09 |