| NPI | 1093891921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 060264) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 27953) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2021-08-10 |