| NPI | 1891955969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2020-03135) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC TL34607) |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2023-07-17 |