| NPI | 1821473299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS14854) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL UO4435) |
| Enumeration Date | 2015-07-27 |
| Last Update Date | 2022-03-17 |