| NPI | 1326073321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101039286) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 10867) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2008-06-11 |