| NPI | 1083686315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101231582) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 79262) |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2011-08-18 |