| NPI | 1659812105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 96390) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS15889) |
| Enumeration Date | 2017-03-16 |
| Last Update Date | 2023-08-16 |