| NPI | 1700810116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 044012) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 37618) |
| 207Q00000X Family Medicine (Licence: GA 44012) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2023-03-16 |