| NPI | 1659869816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC DO51978) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL51978) |
| Enumeration Date | 2018-04-24 |
| Last Update Date | 2021-08-10 |