| NPI | 1447279674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS14643) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH 15495) |
| 207Q00000X Family Medicine (Licence: GA 043788) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2022-02-18 |