| NPI | 1184919573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101252343) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101252343) |
| Enumeration Date | 2011-06-14 |
| Last Update Date | 2023-10-12 |