| NPI | 1154702868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102204964) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD H88467) |
| Enumeration Date | 2015-06-18 |
| Last Update Date | 2023-10-23 |