| NPI | 1427219567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 101661) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD156439) |
| 207Q00000X Family Medicine (Licence: ID MR-0995) | |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2024-09-03 |