| NPI | 1376921494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2021-00108) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 100979) |
| Enumeration Date | 2015-05-08 |
| Last Update Date | 2023-03-07 |