| NPI | 1821296997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 064597) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 140922) |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2022-01-10 |