| NPI | 1134285810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101269450) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 043144) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2020-09-18 |