| NPI | 1205870771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 67598) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME68099) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2025-08-19 |