| NPI | 1639287121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: PR 12343) |
| Additional Taxonomies | 174400000X Specialist (Licence: PR 12343) |
| Enumeration Date | 2006-08-26 |
| Last Update Date | 2024-06-25 |