| NPI | 1730618687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2020-03024) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 226909) |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2022-07-21 |