| NPI | 1720439607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2019-01955) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116029717) |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2022-03-01 |