| NPI | 1952961625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301506744) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4351044540) |
| Enumeration Date | 2019-06-16 |
| Last Update Date | 2022-06-30 |