| NPI | 1124448071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS14025) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 078726) |
| Enumeration Date | 2014-04-18 |
| Last Update Date | 2024-11-26 |