| NPI | 1982860433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 31236) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 069491) |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2023-02-10 |