| NPI | 1912998030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102201700) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 200500055) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2019-07-10 |