| NPI | 1316365547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 26161) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN MD56102) |
| 207Q00000X Family Medicine (Licence: CA A159016) | |
| Enumeration Date | 2014-04-04 |
| Last Update Date | 2018-12-17 |