| NPI | 1326267048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 83261) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101241642) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2023-09-14 |