| NPI | 1720066228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101248748) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 045077) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2017-10-04 |