| NPI | 1194046813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101253929) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116022588) |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2024-02-23 |