| NPI | 1063890838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101264323) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0097012) |
| Enumeration Date | 2015-05-13 |
| Last Update Date | 2024-07-23 |