| NPI | 1831697614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL APRN9405778) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ARNP9405778) |
| Enumeration Date | 2018-01-26 |
| Last Update Date | 2019-06-11 |