| NPI | 1710957444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102201600) |
| Additional Taxonomies | 2083C0008X Preventive Medicine, Clinical Informatics Specialist (Licence: VA 0102201600) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2020-10-27 |