| NPI | 1902124308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 72759) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 14-036) |
| Enumeration Date | 2010-05-10 |
| Last Update Date | 2024-03-21 |