| NPI | 1780652719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102201994) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 52301) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2022-01-04 |