| NPI | 1598746943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 00007157) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 017146) |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2023-01-24 |