| NPI | 1578187266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS20742) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101026964) |
| Enumeration Date | 2020-05-29 |
| Last Update Date | 2024-03-12 |