| NPI | 1871596163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101222971) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DE C1-0006197) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2007-10-09 |