| NPI | 1164845632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102204397) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R09580) |
| Enumeration Date | 2014-02-03 |
| Last Update Date | 2019-05-06 |