| NPI | 1275844847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 066940) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 4325) |
| Enumeration Date | 2010-06-29 |
| Last Update Date | 2020-01-06 |