| NPI | 1487181210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 40894) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 202301220) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2023-08-16 |