| NPI | 1043308661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 29084) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 44600) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2022-07-09 |