| NPI | 1902509995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101284199) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116038914) |
| Enumeration Date | 2023-03-27 |
| Last Update Date | 2025-04-22 |