| NPI | 1346335205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0060052) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101242060) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2011-04-11 |