| NPI | 1831718204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2021-02376) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102207809) |
| Enumeration Date | 2020-04-15 |
| Last Update Date | 2024-07-25 |