| NPI | 1720541931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 91034) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 10788) |
| Enumeration Date | 2019-04-13 |
| Last Update Date | 2023-01-14 |