| NPI | 1396304598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL MD.44681) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 44681) |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2024-02-01 |