| NPI | 1609367416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 52443) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL52443) |
| Enumeration Date | 2018-05-29 |
| Last Update Date | 2024-06-04 |