| NPI | 1265925820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 92395) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 52591) |
| Enumeration Date | 2018-06-08 |
| Last Update Date | 2022-08-17 |