| NPI | 1306017959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102204737) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2014-01055) |
| Enumeration Date | 2008-03-21 |
| Last Update Date | 2017-01-03 |