| NPI | 1881627834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101239953) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0064749) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2024-05-31 |