| NPI | 1366068413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 70114) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL84326) |
| Enumeration Date | 2020-06-24 |
| Last Update Date | 2023-08-02 |