| NPI | 1518544303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 77360) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 9118) |
| Enumeration Date | 2021-03-26 |
| Last Update Date | 2024-02-05 |