| NPI | 1396127569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 38346) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL38346) |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2023-01-05 |