| NPI | 1992955777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101246471) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 25796) |
| 207Q00000X Family Medicine (Licence: MI 4301091115) | |
| Enumeration Date | 2008-09-29 |
| Last Update Date | 2024-09-23 |