| NPI | 1538800354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 81265) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 9531) |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2024-12-16 |