| NPI | 1104019181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 061965) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 001932) |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2019-12-03 |