| NPI | 1497756878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS13041) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA 0S008145-L) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2021-05-11 |