| NPI | 1962462317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 057377) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E-4171) |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2025-09-25 |