| NPI | 1235581539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 57799) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: ND RL14102) |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2024-04-12 |