| NPI | 1700814464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101263052) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD427452) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2020-12-11 |