| NPI | 1609973627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102202739) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 200400731) |
| 207Q00000X Family Medicine (Licence: WV 1950) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2019-01-30 |