| NPI | 1124443445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101260350) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0081664) |
| Enumeration Date | 2014-02-24 |
| Last Update Date | 2022-11-15 |