| NPI | 1710100474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 202K00000X (Licence: VA 0101243799) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD32949) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2022-02-08 |