| NPI | 1427052786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101045075) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN MD 21464) |
| Enumeration Date | 2005-06-02 |
| Last Update Date | 2011-06-23 |