| NPI | 1306824289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101247409) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI MD13354) |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2020-12-09 |