| NPI | 1558775601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102204488) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116027315) |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2022-06-10 |