| NPI | 1972954006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E-17923) |
| Additional Taxonomies | 208D00000X General Practice (Licence: LA 307302) |
| Enumeration Date | 2016-06-30 |
| Last Update Date | 2024-08-28 |