| NPI | 1174968853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0031380) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN MD24777) |
| Enumeration Date | 2013-05-08 |
| Last Update Date | 2024-05-07 |