| NPI | 1982670949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: MD D0066377) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101058070) |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2011-11-15 |