| NPI | 1801232400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME121045) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E-15332) |
| Enumeration Date | 2013-05-22 |
| Last Update Date | 2024-12-09 |