| NPI | 1528297538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 66666) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 1263) |
| Enumeration Date | 2009-07-11 |
| Last Update Date | 2018-06-04 |