| NPI | 1871941724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O-1091) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRO-1579) |
| Enumeration Date | 2016-06-01 |
| Last Update Date | 2020-04-15 |