| NPI | 1922265321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101265063) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD444370) |
| Enumeration Date | 2008-05-22 |
| Last Update Date | 2022-03-31 |