| NPI | 1114958808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101253600) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD072204L) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2014-03-07 |