| NPI | 1932165040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN MD38979) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101250280) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2026-02-16 |