| NPI | 1437218799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101263675) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 38137) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2023-10-11 |