| NPI | 1881805307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101259536) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA MD.202456) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2022-01-07 |