| NPI | 1174789465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101258966) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT 12693) |
| 207Q00000X Family Medicine (Licence: NC 148722) | |
| Enumeration Date | 2008-08-06 |
| Last Update Date | 2023-02-02 |