| NPI | 1295020683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102208191) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 008135) |
| Enumeration Date | 2011-06-14 |
| Last Update Date | 2024-03-26 |