| NPI | 1588288435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2023030282) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-11913) |
| Enumeration Date | 2020-06-05 |
| Last Update Date | 2024-11-08 |