| NPI | 1881261113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2024-01093) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC MMD.86255) |
| Enumeration Date | 2021-06-07 |
| Last Update Date | 2024-11-13 |