| NPI | 1720045552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 068022) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 15430) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2020-08-05 |