| NPI | 1689635195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101223904) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR C-8408) |
| 207Q00000X Family Medicine (Licence: FL ME66807) | |
| Enumeration Date | 2006-04-01 |
| Last Update Date | 2008-04-28 |