| NPI | 1427041656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101038474) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 101996) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2024-10-29 |