| NPI | 1386672392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E5005) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 4104) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2020-09-09 |