| NPI | 1114990009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101-102655) |
| Additional Taxonomies | 174400000X Specialist (Licence: VA 0101102655) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2013-07-25 |