| NPI | 1568401610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102202590) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS010113L) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2024-11-11 |