| NPI | 1710411517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 160563) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 122943) |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2023-02-02 |