| NPI | 1508873019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 8885) |
| Additional Taxonomies | 208D00000X General Practice (Licence: SC 8885) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2022-08-12 |