| NPI | 1790019792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0042773) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101052347) |
| Enumeration Date | 2009-09-23 |
| Last Update Date | 2009-09-23 |