| NPI | 1235611161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2018017320) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MO 2018017320) |
| Enumeration Date | 2018-09-06 |
| Last Update Date | 2018-10-24 |