| NPI | 1790764009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101240108) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 35098) |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2025-05-22 |