| NPI | 1871770412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 63748) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 063748) |
| Enumeration Date | 2008-01-25 |
| Last Update Date | 2026-08-24 |