| NPI | 1861018210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2022028860) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2020015982) |
| Enumeration Date | 2020-06-22 |
| Last Update Date | 2023-01-11 |