| NPI | 1457587842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 65703) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 065703) |
| Enumeration Date | 2009-05-31 |
| Last Update Date | 2020-07-16 |