| NPI | 1790883866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101246993) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 059965) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2013-08-08 |