| NPI | 1093854259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 010124807) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 200704) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2010-03-26 |