| NPI | 1104271832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101265330) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116029855) |
| Enumeration Date | 2016-05-02 |
| Last Update Date | 2018-09-13 |