| NPI | 1053976340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101278800) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101278800) |
| 208000000X Pediatrics (Licence: VA 0101278800) | |
| Enumeration Date | 2019-05-02 |
| Last Update Date | 2024-01-19 |