| NPI | 1013956663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 37735) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN DO1433) |
| 207Q00000X Family Medicine (Licence: VA 0102201965) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2023-11-28 |