| NPI | 1316175797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 72824) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D74188) |
| Enumeration Date | 2009-06-24 |
| Last Update Date | 2023-07-31 |