| NPI | 1548686447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2021-03367) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 18800) |
| Enumeration Date | 2014-03-16 |
| Last Update Date | 2022-08-25 |