| NPI | 1720283807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD H72413) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102202082) |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2019-05-28 |