| NPI | 1316641848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 84264) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 100124) |
| Enumeration Date | 2023-03-28 |
| Last Update Date | 2024-07-11 |