| NPI | 1306330154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101025052) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101024062) |
| Enumeration Date | 2018-06-15 |
| Last Update Date | 2022-07-21 |