| NPI | 1720642929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2022-01018) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 250076) |
| Enumeration Date | 2019-04-24 |
| Last Update Date | 2023-03-21 |