| NPI | 1477871663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101253976) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2014-00488) |
| Enumeration Date | 2010-05-12 |
| Last Update Date | 2023-12-12 |