| NPI | 1073557047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102202903) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS-010723L) |
| 207Q00000X Family Medicine (Licence: WV 2379) | |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2015-04-06 |