| NPI | 1952751661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD219026) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101262937) |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2024-02-12 |