| NPI | 1265403547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102201540) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN DO695) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2020-02-05 |