| NPI | 1376521708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101045149) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN MD26094) |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2022-10-12 |