| NPI | 1023093655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 37500) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR C 7965) |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2015-04-06 |