| NPI | 1336632918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 010101) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 37459639) |
| Enumeration Date | 2018-06-08 |
| Last Update Date | 2023-07-05 |