| NPI | 1780043125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102204938) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0102204938) |
| Enumeration Date | 2016-02-13 |
| Last Update Date | 2023-10-09 |