| NPI | 1003278144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 042-0017011) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E-12208) |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2024-04-22 |