| NPI | 1003873159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 01010029800) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D25137) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2010-07-07 |