| NPI | 1710921689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 27787) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 040111) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2024-05-23 |