| NPI | 1801884887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 1377) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS7932) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2023-02-17 |