| NPI | 1174696595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 17217) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN md17219) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2021-09-30 |