| NPI | 1326099177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101240677) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD MD039129) |
| 207Q00000X Family Medicine (Licence: MD D65501) | |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2022-02-04 |