| NPI | 1194081851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 84511) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME121902) |
| Enumeration Date | 2012-04-06 |
| Last Update Date | 2020-05-15 |