| NPI | 1306872981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 36631) |
| Additional Taxonomies | 207QA0000X Family Medicine Adolescent Medicine (Licence: TN 36631) |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2022-07-05 |