| NPI | 1124021407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN MD 11894) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101028967) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2009-09-22 |