| NPI | 1467953232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102207432) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC DO035010) |
| Enumeration Date | 2018-02-26 |
| Last Update Date | 2023-01-09 |