| NPI | 1922157106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101246050) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D77762) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2018-04-12 |