| NPI | 1790363661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2024-01751) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL83624) |
| Enumeration Date | 2021-03-31 |
| Last Update Date | 2024-11-06 |