| NPI | 1508328014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301506520) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 9999999) |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2022-08-09 |