| NPI | 1417188103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 79227) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL MD.33421) |
| Enumeration Date | 2009-07-29 |
| Last Update Date | 2023-11-02 |