| NPI | 1891289484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102205850) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GU DO-0113) |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2024-08-13 |