| NPI | 1164460200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 69571) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 36721) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2024-01-19 |