| NPI | 1548548498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 13221) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2024036446) |
| Enumeration Date | 2011-07-26 |
| Last Update Date | 2024-09-10 |