| NPI | 1457640666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME109256) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: NM MD2008/0604) |
| Enumeration Date | 2011-03-29 |
| Last Update Date | 2024-02-06 |