| NPI | 1407351869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 85727) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 11405459-1205) |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2021-12-08 |