| NPI | 1336680560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 3896) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 83276) |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2023-01-30 |