| NPI | 1902166044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 64273) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 005434) |
| Enumeration Date | 2012-05-23 |
| Last Update Date | 2026-05-19 |