| NPI | 1689723793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102201879) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD 235439) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2024-05-07 |