| NPI | 1689652752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2022031685) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101242646) |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2022-10-28 |