| NPI | 1922666379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101026960) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5151013646) |
| 207Q00000X Family Medicine (Licence: MI 5315234969) | |
| Enumeration Date | 2019-05-31 |
| Last Update Date | 2023-01-27 |