| NPI | 1275186165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 332738) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2019023776) |
| Enumeration Date | 2019-07-19 |
| Last Update Date | 2022-08-03 |