| NPI | 1407142110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101253085) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116023490) |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2026-03-31 |