| NPI | 1891356036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301505320) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4351044827) |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2022-07-08 |