| NPI | 1770975278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 76654) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT 63958) |
| Enumeration Date | 2015-02-21 |
| Last Update Date | 2023-01-10 |