| NPI | 1598025462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS19346) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 264414) |
| Enumeration Date | 2012-05-24 |
| Last Update Date | 2023-01-11 |