| NPI | 1962849679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 82965) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 82269) |
| 207Q00000X Family Medicine (Licence: WA OP60668372) | |
| Enumeration Date | 2013-06-04 |
| Last Update Date | 2021-05-22 |