| NPI | 1164166336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 35291) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 74370) |
| Enumeration Date | 2022-04-25 |
| Last Update Date | 2025-09-04 |