| NPI | 1952807554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 75016) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 52613) |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2021-11-18 |