| NPI | 1326336793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 04064) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 2827) |
| 207Q00000X Family Medicine (Licence: VA 0102204025) | |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2023-02-09 |