| NPI | 1326056839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 40238) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 21839) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2022-02-04 |