| NPI | 1386706018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101240789) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101240789) |
| Enumeration Date | 2006-12-16 |
| Last Update Date | 2009-11-03 |