| NPI | 1184787871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101043123) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 027034) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2023-01-10 |