| NPI | 1841749355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101268907) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL HSE24008) |
| Enumeration Date | 2016-09-26 |
| Last Update Date | 2020-08-07 |