| NPI | 1295841054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 14136) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 20079) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2016-01-05 |