| NPI | 1154581437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 47578) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101250073) |
| 207Q00000X Family Medicine (Licence: KY 44663) | |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2020-12-15 |