| NPI | 1952929481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101272884) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2024-02599) |
| Enumeration Date | 2020-07-10 |
| Last Update Date | 2025-06-20 |