| NPI | 1942697495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 80316) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E-17756) |
| Enumeration Date | 2015-04-22 |
| Last Update Date | 2024-06-02 |