| NPI | 1396367389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 136501) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 34156) |
| Enumeration Date | 2020-05-12 |
| Last Update Date | 2024-04-05 |