| NPI | 1548452345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101252598) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2007-01164) |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2021-03-12 |