| NPI | 1235164096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN MD40492) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA C159386) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2022-11-15 |