| NPI | 1871023135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 161270) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRO-1658) |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2024-10-03 |