| NPI | 1790429686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101284975) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0101924) |
| Enumeration Date | 2022-04-26 |
| Last Update Date | 2025-07-28 |