| NPI | 1952593691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101033705) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME 51346) |
| Enumeration Date | 2007-08-16 |
| Last Update Date | 2007-08-16 |