| NPI | 1588192801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 83721) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 009053) |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2024-05-23 |