| NPI | 1992067474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GU M-2165) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116024649) |
| Enumeration Date | 2012-06-11 |
| Last Update Date | 2020-05-26 |