| NPI | 1538196704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 5182) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 28115-021) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2024-07-26 |