| NPI | 1902247596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME125105) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN 18541) |
| Enumeration Date | 2013-07-11 |
| Last Update Date | 2021-03-25 |