| NPI | 1568925857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0101273488) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101273488) |
| Enumeration Date | 2019-04-12 |
| Last Update Date | 2022-02-01 |