| NPI | 1245646587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 59406) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME129135) |
| Enumeration Date | 2014-07-08 |
| Last Update Date | 2019-11-23 |