| NPI | 1306069380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 60867) |
| Additional Taxonomies | 208D00000X General Practice (Licence: GA 060867) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2024-09-05 |