| NPI | 1316940935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101053559) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM 99-6) |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2018-12-11 |