| NPI | 1487003216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 39665) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL39665) |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2023-09-11 |