| NPI | 1174262620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101286369) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 87943) |
| Enumeration Date | 2022-06-02 |
| Last Update Date | 2025-07-29 |