| NPI | 1982861258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101254199) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0071293) |
| 207Q00000X Family Medicine (Licence: CA A105067) | |
| Enumeration Date | 2008-05-22 |
| Last Update Date | 2022-02-17 |