| NPI | 1447305172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101246371) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 200401092) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2016-04-13 |