| NPI | 1255592390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 66943) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 14495) |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2024-06-10 |