| NPI | 1952558678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101252128) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 001794) |
| Enumeration Date | 2008-08-25 |
| Last Update Date | 2022-08-08 |