| NPI | 1447278734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101268983) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 18074) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2022-01-20 |