| NPI | 1982773610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 048844) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA GA48844) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2020-10-02 |