| NPI | 1730539297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 320725) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN23856) |
| Enumeration Date | 2016-06-15 |
| Last Update Date | 2019-09-30 |