| NPI | 1295476935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101285157) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116037611) |
| Enumeration Date | 2022-04-06 |
| Last Update Date | 2025-07-22 |