| NPI | 1346243631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN MD 9839) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101027369) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2009-09-18 |