| NPI | 1073597027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101235146) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101235146) |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2026-03-17 |