| NPI | 1336586650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI 2375-0) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2017014165) |
| Enumeration Date | 2013-05-28 |
| Last Update Date | 2024-04-26 |