| NPI | 1225267495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101248025) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116021720) |
| Enumeration Date | 2009-07-09 |
| Last Update Date | 2023-05-22 |