| NPI | 1831180165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102049868) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102-049868) |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2013-01-10 |