| NPI | 1487218814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O-1468) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRO-1839) |
| Enumeration Date | 2019-05-01 |
| Last Update Date | 2022-08-12 |