| NPI | 1083662241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 36087) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 731) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2021-04-01 |