| NPI | 1851354740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 49976) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 049976) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2023-09-15 |