| NPI | 1730574245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO178280) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR pg172017) |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2023-03-17 |