| NPI | 1295882348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 53885) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 26547) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2019-11-12 |