| NPI | 1841293586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN MD 18855) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101042546) |
| Enumeration Date | 2005-05-26 |
| Last Update Date | 2009-09-18 |