| NPI | 1174564314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 41313) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E-3567) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2021-03-18 |