| NPI | 1497724322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101051674) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 13077) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2016-02-02 |