| NPI | 1316942444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 92613) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101037646) |
| 207Q00000X Family Medicine (Licence: WI 49962-020) | |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2022-11-16 |