| NPI | 1801209713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102207758) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL36689) |
| 207Q00000X Family Medicine (Licence: PA OS019404) | |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2025-02-17 |