| NPI | 1558407437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101240975) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 01012409756) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2023-08-24 |