| NPI | 1568032712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2023006982) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO temporary) |
| Enumeration Date | 2021-06-30 |
| Last Update Date | 2023-03-02 |