| NPI | 1760053821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO-06380) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-12318) |
| Enumeration Date | 2021-07-08 |
| Last Update Date | 2024-09-13 |