| NPI | 1427058411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 016413) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101030795) |
| Enumeration Date | 2005-07-30 |
| Last Update Date | 2018-06-04 |