| NPI | 1760472096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 87077) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME51666) |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2023-04-13 |