| NPI | 1861874547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 101129) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101260756) |
| Enumeration Date | 2015-06-18 |
| Last Update Date | 2025-11-20 |