| NPI | 1265848576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: VA 0101260556) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116027332) |
| Enumeration Date | 2014-07-08 |
| Last Update Date | 2024-04-11 |