| NPI | 1043229412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101255950) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 67308) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2024-10-07 |