| NPI | 1457702870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101267172) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 23598) |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2019-07-29 |