| NPI | 1760972780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O-1319) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT 96914) |
| 207Q00000X Family Medicine (Licence: ID MRO-1730) | |
| Enumeration Date | 2018-05-15 |
| Last Update Date | 2022-05-23 |