| NPI | 1366893281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 76411) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ R75735) |
| 207Q00000X Family Medicine (Licence: AZ 57761) | |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2024-01-19 |