| NPI | 1902865470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS17317) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 3071) |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2022-08-10 |