| NPI | 1255394557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101221492) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 044253) |
| Enumeration Date | 2006-04-08 |
| Last Update Date | 2007-07-08 |