| NPI | 1275723900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2010-00429) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116019782) |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2010-08-31 |