| NPI | 1699355131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 202426669) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA 0T020540) |
| 207Q00000X Family Medicine (Licence: PA OS022630) | |
| Enumeration Date | 2021-04-09 |
| Last Update Date | 2024-08-01 |