| NPI | 1861686834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102202214) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 1899) |
| 207Q00000X Family Medicine (Licence: AR E5432) | |
| Enumeration Date | 2007-08-31 |
| Last Update Date | 2010-12-20 |