| NPI | 1861176182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2024040709) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2023022824) |
| Enumeration Date | 2023-06-15 |
| Last Update Date | 2024-12-14 |