| NPI | 1730344094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 68147) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 668147) |
| Enumeration Date | 2008-07-25 |
| Last Update Date | 2026-06-18 |