| NPI | 1831139336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101230316) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 010266823) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2025-01-22 |