| NPI | 1215002928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101242260) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 7419A) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2022-08-29 |