| NPI | 1265497325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 070878) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 25227) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2022-01-10 |