| NPI | 1952797425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101272335) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 264518) |
| Enumeration Date | 2015-04-12 |
| Last Update Date | 2021-07-27 |