| NPI | 1679543623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 16907) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101038397) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2018-06-04 |