| NPI | 1275562720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101252765) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 043192) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2016-02-19 |