| NPI | 1457513186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 66098) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301092742) |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2020-09-29 |