| NPI | 1629607783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 76454) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 8725) |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2024-01-22 |