| NPI | 1124150016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 45549) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 29024) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2011-08-09 |