| NPI | 1861462426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN MD27152) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101054051) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2013-04-29 |