| NPI | 1548372006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: GA 63977) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: MI 4301-064678) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2022-09-21 |