| NPI | 1821039660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 066252) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 19004) |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2024-10-11 |