| NPI | 1851373013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101048386) |
| Additional Taxonomies | 174400000X Specialist (Licence: VA 0101048386) |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2012-01-31 |