| NPI | 1598806192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E0593) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 112253) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2020-06-16 |