| NPI | 1932361730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101254246) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL31105) |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2026-02-03 |