| NPI | 1679100796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2023-01759) |
| Additional Taxonomies | 208D00000X General Practice (Licence: SC 83170) |
| 207Q00000X Family Medicine (Licence: SC 83170) | |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2023-11-14 |