| NPI | 1386965416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 69238) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 069238) |
| Enumeration Date | 2010-06-11 |
| Last Update Date | 2022-02-15 |