| NPI | 1598713851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102201555) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD H0082752) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2024-05-07 |