| NPI | 1093881377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101027294) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 200200207) |
| 207Q00000X Family Medicine (Licence: MA D0058041) | |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2007-07-08 |