| NPI | 1568983336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4351039722) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301113398) |
| Enumeration Date | 2017-07-03 |
| Last Update Date | 2022-07-21 |