| NPI | 1700101110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102202667) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 3674) |
| 207Q00000X Family Medicine (Licence: UT 7531391-1204) | |
| Enumeration Date | 2010-03-30 |
| Last Update Date | 2023-06-14 |