| NPI | 1316562838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 84211) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL84211) |
| Enumeration Date | 2020-06-10 |
| Last Update Date | 2024-01-18 |