| NPI | 1821115585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 59822) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 000547) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2024-01-03 |