| NPI | 1457556557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 64500) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 29759) |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2024-01-30 |