| NPI | 1619460987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101267560) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101267560) |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2025-01-14 |