| NPI | 1053320127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 82068) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101010064) |
| Enumeration Date | 2006-08-06 |
| Last Update Date | 2020-05-22 |