| NPI | 1245260199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME83792) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA g53342) |
| 207Q00000X Family Medicine (Licence: TN MD 016325) | |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2023-08-18 |