| NPI | 1679986525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 78161) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN 19930) |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2021-01-26 |