| NPI | 1144231952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 31979) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 18219) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2018-03-21 |