| NPI | 1902291792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2017-01590) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 209342) |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2023-04-25 |