| NPI | 1710981535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN MD 25864) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101051348) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2023-01-25 |