| NPI | 1639563133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101285299) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 29425) |
| Enumeration Date | 2015-03-23 |
| Last Update Date | 2025-06-16 |