| NPI | 1346287117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 61463) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 061463) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2022-01-07 |