| NPI | 1720058274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101042399) |
| Additional Taxonomies | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: VA 0101042399) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2007-07-08 |