| NPI | 1033107701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101035356) |
| Additional Taxonomies | 174400000X Specialist (Licence: VA 0101035356) |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2016-11-09 |