| NPI | 1366679904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101251610) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 31946) |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2016-04-18 |