| NPI | 1386268860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0116033794) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 89624) |
| Enumeration Date | 2020-06-01 |
| Last Update Date | 2023-05-18 |