| NPI | 1902198799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2022025616) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2014-01389) |
| Enumeration Date | 2011-05-11 |
| Last Update Date | 2022-07-13 |