| NPI | 1548754864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101267852) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116031485) |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2021-09-07 |