| NPI | 1821225152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: VA 0101248100) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101248100) |
| Enumeration Date | 2009-06-12 |
| Last Update Date | 2023-02-02 |