| NPI | 1467914515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101275641) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2021-00215) |
| Enumeration Date | 2019-04-05 |
| Last Update Date | 2022-10-02 |