| NPI | 1821416496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102204457) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA T63256393) |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2024-02-05 |