| NPI | 1467428987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 19714) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101047148) |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2018-11-01 |