| NPI | 1356310759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 22084) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101047713) |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2013-05-03 |