| NPI | 1265777403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN DO2673) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2012030151) |
| Enumeration Date | 2012-11-28 |
| Last Update Date | 2020-06-12 |