| NPI | 1922458454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2019012277) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2016018012) |
| Enumeration Date | 2016-06-15 |
| Last Update Date | 2022-09-13 |