| NPI | 1811166366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101247115) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT190089) |
| Enumeration Date | 2008-02-28 |
| Last Update Date | 2012-08-08 |