| NPI | 1457324238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102036945) |
| Additional Taxonomies | 207RI0200X Internal Medicine, Infectious Disease (Licence: VA 0102036945) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2009-01-29 |