| NPI | 1194721019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS9454) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 044062) |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2024-06-13 |