| NPI | 1861058927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2020-04057) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 252002) |
| Enumeration Date | 2019-05-14 |
| Last Update Date | 2022-09-08 |