| NPI | 1073945796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS14106) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 100438) |
| Enumeration Date | 2013-08-05 |
| Last Update Date | 2024-07-10 |