| NPI | 1821541723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 007732) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ R2622) |
| Enumeration Date | 2016-07-27 |
| Last Update Date | 2022-08-30 |