| NPI | 1609404714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 128516) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA 61329456) |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2024-05-20 |