| NPI | 1003926353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 43411) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101241364) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2009-09-16 |