| NPI | 1841729910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 47374) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2017018876) |
| Enumeration Date | 2017-06-12 |
| Last Update Date | 2020-08-10 |