| NPI | 1467559658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 118290) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 044301) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2024-11-15 |