| NPI | 1720575871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM DO2024-0004) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A17902) |
| Enumeration Date | 2018-04-15 |
| Last Update Date | 2024-01-11 |