| NPI | 1790048239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2020034539) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE Anthony 6740) |
| 208D00000X General Practice (Licence: KS 0438079) | |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2020-10-16 |