| NPI | 1780352088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4351049950) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2021016377) |
| 207R00000X Internal Medicine (Licence: MO 2021016377) | |
| Enumeration Date | 2021-09-01 |
| Last Update Date | 2022-05-19 |