| NPI | 1275026908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 89035) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 42431) |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2024-07-15 |