| NPI | 1235706631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 101121) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 12883) |
| Enumeration Date | 2021-06-05 |
| Last Update Date | 2024-10-11 |