| NPI | 1720648157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2022020790) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5151013682) |
| 207Q00000X Family Medicine (Licence: MI 5101026044) | |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2023-04-04 |