| NPI | 1831382704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 82023) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2010-00395) |
| 207Q00000X Family Medicine (Licence: SC 29178) | |
| Enumeration Date | 2007-08-23 |
| Last Update Date | 2022-10-26 |