| NPI | 1306461678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS19559) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116033702) |
| Enumeration Date | 2020-06-12 |
| Last Update Date | 2023-06-09 |