| NPI | 1578182358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 109477) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 43087) |
| Enumeration Date | 2020-04-13 |
| Last Update Date | 2025-12-09 |