| NPI | 1891372199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 101650) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 46806) |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2024-10-02 |