| NPI | 1154542926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 43694) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME136038) |
| 207Q00000X Family Medicine (Licence: MS 21363) | |
| 207Q00000X Family Medicine (Licence: LA MD.204303) | |
| 207Q00000X Family Medicine (Licence: AR E-5144) | |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2018-07-16 |