| NPI | 1467955211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO216490) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR PG199635) |
| Enumeration Date | 2018-03-16 |
| Last Update Date | 2023-08-18 |