| NPI | 1801859814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101264900) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 200301111) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2023-03-07 |