| NPI | 1306365051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101270157) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 9561) |
| Enumeration Date | 2017-09-13 |
| Last Update Date | 2024-10-10 |