| NPI | 1588643597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101256394) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2017-00185) |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2026-08-05 |