| NPI | 1134121320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 18226) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101041214) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2014-05-15 |