| NPI | 1962441436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR R-4659) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AR R-4659) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2024-08-16 |