| NPI | 1578913976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 39787) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL39787) |
| Enumeration Date | 2016-06-16 |
| Last Update Date | 2023-01-05 |