| NPI | 1821228255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 076284) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND RL11257) |
| 207Q00000X Family Medicine (Licence: ND 11941) | |
| Enumeration Date | 2009-07-20 |
| Last Update Date | 2022-07-21 |