| NPI | 1801241914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102206006) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 218045) |
| Enumeration Date | 2016-04-26 |
| Last Update Date | 2021-08-25 |