| NPI | 1861788028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E8550) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 4044) |
| Enumeration Date | 2011-06-24 |
| Last Update Date | 2024-09-03 |