| NPI | 1508392333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 85292) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 40938) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2021-12-28 |