| NPI | 1689740136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101027481) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 12875) |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2022-03-08 |