| NPI | 1386178184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 70279-21) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 70279) |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2024-08-22 |