| NPI | 1740774439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O-1336) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRO-1739) |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2021-11-15 |