| NPI | 1932737491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 3262) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD 83249) |
| 208D00000X General Practice (Licence: SC 83249) | |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2023-06-28 |