| NPI | 1013238856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 50275) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 32845) |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2023-04-12 |