| NPI | 1033112438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 52705) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 52705) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2023-03-16 |