| NPI | 1669864856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 5494) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL MD.44375) |
| Enumeration Date | 2015-02-24 |
| Last Update Date | 2022-10-11 |