| NPI | 1952305609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101054251) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN MD 34234) |
| Enumeration Date | 2005-06-10 |
| Last Update Date | 2018-01-30 |