| NPI | 1871909523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 073867) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL UO3275) |
| Enumeration Date | 2014-07-02 |
| Last Update Date | 2023-11-12 |