| NPI | 1104113570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101255849) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT200635) |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2023-11-27 |