| NPI | 1891777355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 056426) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 056424) |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2023-03-21 |