| NPI | 1851428965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101033826) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D24869) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2018-09-11 |