| NPI | 1508435322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2024-00459) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116035585) |
| Enumeration Date | 2021-06-24 |
| Last Update Date | 2024-08-19 |