| NPI | 1750875969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2020022686) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-11355) |
| 207Q00000X Family Medicine (Licence: IA DO-05506) | |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2021-10-01 |