| NPI | 1720068711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 15408) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101039578) |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2007-07-08 |