| NPI | 1336401728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102203815) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 78492) |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2022-08-05 |