| NPI | 1184635518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101035436) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101035436) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2010-12-08 |