| NPI | 1528091683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102202742) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS9302) |
| 207Q00000X Family Medicine (Licence: GA 058664) | |
| 207Q00000X Family Medicine (Licence: MD H0071658) | |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2012-06-07 |