| NPI | 1447411525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 104701) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AL DO1459) |
| 207Q00000X Family Medicine (Licence: FL OS15776) | |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2025-12-12 |