| NPI | 1427026319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 45484) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101036227) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2012-02-08 |