| NPI | 1699333898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301505545) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4351045129) |
| Enumeration Date | 2019-06-03 |
| Last Update Date | 2021-08-30 |