| NPI | 1164664066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 45984) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: TN 45984) |
| Enumeration Date | 2009-03-24 |
| Last Update Date | 2021-08-31 |