| NPI | 1902433923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 85693) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL85693) |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2024-07-23 |