| NPI | 1326509324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC LL83267) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 28-83267) |
| Enumeration Date | 2019-03-31 |
| Last Update Date | 2020-07-06 |