| NPI | 1619137080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 46298) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101250015) |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2020-01-17 |