| NPI | 1629638887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0116032977) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO CDR.0002886) |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2023-07-27 |