| NPI | 1528221900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102202612) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 2448) |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2016-07-27 |