| NPI | 1447277256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 032943) |
| Additional Taxonomies | 208D00000X General Practice (Licence: GA 32943) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2021-02-25 |