| NPI | 1922130228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101240385) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D008020) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2023-03-05 |