| NPI | 1326071184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 1725) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 102050207) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2018-06-26 |