| NPI | 1528802675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102209631) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116039798) |
| Enumeration Date | 2024-06-24 |
| Last Update Date | 2026-05-07 |