| NPI | 1780241430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 93544) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-11459) |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2024-09-17 |