| NPI | 1114364130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 078699) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116025893) |
| Enumeration Date | 2013-05-31 |
| Last Update Date | 2022-07-21 |