| NPI | 1013139906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 25725) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 241884) |
| 207Q00000X Family Medicine (Licence: GA 40938) | |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2020-02-25 |