| NPI | 1588105415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO208658) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102206703) |
| Enumeration Date | 2017-03-10 |
| Last Update Date | 2024-03-25 |