| NPI | 1689249427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A197783) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GU TLL-2024-006) |
| Enumeration Date | 2021-05-24 |
| Last Update Date | 2024-09-05 |