| NPI | 1184884439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101246884) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 116020253) |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2022-08-11 |