| NPI | 1225568587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102205571) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116030465) |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2020-06-23 |