| NPI | 1982220281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 93936) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 11757) |
| Enumeration Date | 2020-06-23 |
| Last Update Date | 2023-09-15 |