| NPI | 1144256157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 14266) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 16404) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2010-11-19 |