| NPI | 1801388822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2021-0247) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301115616) |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2021-07-21 |