| NPI | 1316485246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM A-2429-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS16377) |
| Enumeration Date | 2017-02-12 |
| Last Update Date | 2021-01-15 |