| NPI | 1508077611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101243625) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116017177) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2025-01-08 |