| NPI | 1447411525 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS15776) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AL DO1459) |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2025-02-08 |