| NPI | 1366608481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101247914) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116020097) |
| Enumeration Date | 2008-07-29 |
| Last Update Date | 2012-02-09 |