| NPI | 1609505999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 32965) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ R3797) |
| Enumeration Date | 2022-06-10 |
| Last Update Date | 2024-06-17 |