| NPI | 1467469775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102202124) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 2070) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2023-07-21 |