| NPI | 1982348892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101281412) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116037126) |
| Enumeration Date | 2022-04-26 |
| Last Update Date | 2025-06-16 |