| NPI | 1760235600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5151016783) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5315248864) |
| Enumeration Date | 2024-04-10 |
| Last Update Date | 2024-04-14 |