| NPI | 1598745036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI MD19520) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101057270) |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2024-10-07 |