| NPI | 1780875781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 91021) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-8291) |
| 207Q00000X Family Medicine (Licence: IA 39084) | |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2022-03-05 |