| NPI | 1093735458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E-4471) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 39142) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2018-08-17 |