| NPI | 1982086070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0116028506) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102204699) |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2023-11-13 |