| NPI | 1033368246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR C-6467) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AR C6467) |
| Enumeration Date | 2008-09-11 |
| Last Update Date | 2019-10-17 |