| NPI | 1245263524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101239065) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD429426) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2021-09-03 |