| NPI | 1942233184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102201307) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 740) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2007-12-08 |