| NPI | 1891311254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E16739) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2020016995) |
| Enumeration Date | 2020-06-22 |
| Last Update Date | 2023-08-31 |